Key lines of enquiry, prompts and ratings characteristics ...

1 Key lines of enquiry, prompts and ratings characteristics adult social care services 1 Key lines of enquiry, prompts and ratings characteristics for adult social care services Key lines of enquiry and prompts : Page Safe .. 3 Effective ..11 Caring ..16 Responsive ..20 Well-led ..25 ratings characteristics Safe ..31 Effective ..43 Caring ..52 Responsive ..57 Well-led ..64 Key lines of enquiry, prompts and ratings characteristics adult social care services 2 Notes on this updated assessment framework CQC s inspection teams will use this updated framework to assess adult social care services, using the key lines of enquiry (KLOEs) and prompts where they are appropriate. This replaces the previous separate versions for different types of service, published in 2015, which duplicated many of the KLOEs and prompts . We have designed this to simplify the process for organisations that provide more than one type of service.

2 The changes to KLOEs and prompts are the result of feedback following our Next Phase consultation. We have merged the two previous versions for residential and community care , added new content to strengthen specific areas and reflect current practice, and made some changes to the wording to improve and simplify the language to aid understanding. We have also aligned, as much as possible, the wording of KLOEs and prompts between the two assessment frameworks for healthcare services and adult social care services. To help you update your own internal assessment and training materials, we have mapped the changes against the current frameworks and highlighted them. Key lines of enquiry and prompts : SAFE Key lines of enquiry, prompts and ratings characteristics adult social care services 3 Notes: 1. All key lines of enquiry and prompts are mandatory for both community and residential adult social care services, where relevant.

3 2. Where we refer to people , we include adults , young people and children, where applicable. Key to type of change No or minimal change to wording for clarity/moved or merged prompts Changed Substantive change to wording New New key line of enquiry or prompt, including those that are new for some, but not all, sectors Safe By safe, we mean people are protected from abuse* and avoidable harm. *Abuse can be physical, sexual, mental or psychological, financial, neglect, institutional or discriminatory abuse. Code Key line of enquiry / prompt Reason for change Applies to S1 New How do systems, processes and practices safeguard people from abuse? Wording aligned with health All services New How are safeguarding systems, processes and practices developed, implemented and communicated to staff? Wording aligned with health All services Key lines of enquiry and prompts : SAFE Key lines of enquiry, prompts and ratings characteristics adult social care services 4 Code Key line of enquiry / prompt Reason for change Applies to Substantive change How do systems, processes and practices protect people from abuse, neglect, harassment and breaches of their dignity and respect?

4 How are these monitored and improved? Feedback from consultation and wording aligned with health All services Substantive change How are people protected from discrimination, which might amount to abuse or cause psychological harm? This includes harassment and discrimination in relation to protected characteristics under the Equality Act. Wording aligned with health All services Substantive change How are people supported to understand what keeping safe means, and how are they encouraged and empowered to raise any concerns they may have about this? If people are subject to safeguarding enquiries or an investigation, are they offered an advocate if appropriate or required? Feedback from consultation All services Substantive change How are risks to people assessed and their safety monitored and managed so they are supported to stay safe and their freedom is respected? Wording aligned with health All services Substantive change What arrangements are there to manage risks appropriately, and to make sure that people are involved in decisions about any risks they may take?

5 Feedback from consultation All services Substantive change How do risk management policies and procedures minimise restrictions on people s freedom, choice and control, in particular for people who lack mental capacity? Feedback from consultation All services Key lines of enquiry and prompts : SAFE Key lines of enquiry, prompts and ratings characteristics adult social care services 5 Code Key line of enquiry / prompt Reason for change Applies to New Are people s records accurate, complete, legible, up-to-date, securely stored and available to relevant staff so that they support people to stay safe? Wording aligned with health All services Substantive change Are formal and informal methods used to share information with appropriate parties on risks to people s care , treatment and support? Feedback from consultation All services Are there thorough, questioning and objective investigations into whistleblowing or staff concerns, safeguarding, and accidents or incidents?

6 Are action plans developed, and are they monitored to make sure they are delivered? All services Substantive change How is equipment, which is owned or used by the provider, managed to support people to stay safe? How are the premises and safety of communal and personal spaces (such as bedrooms) and the living environment checked and managed to support people to stay safe? How does the provider manage risks where they provide support in premises they are not responsible for? Feedback from consultation Equipment used: All services Premises management: care homes Premises risks: All services Substantive change How do staff seek to understand, prevent and manage behaviour that the service finds challenging? How are individuals supported when their behaviour challenges? How well does this align with best practice? Moved from Effective and Feedback from consultation All services S3 How does the service make sure that there are sufficient numbers of suitable staff to support people to stay safe and meet their needs?

7 All services Key lines of enquiry and prompts : SAFE Key lines of enquiry, prompts and ratings characteristics adult social care services 6 Code Key line of enquiry / prompt Reason for change Applies to Substantive change What arrangements are there, including within the rotas, for making sure that staff have the right mix of skills, competencies, qualifications, experience and knowledge, to meet people s individual needs? Feedback from consultation All services Substantive change How is safety promoted in recruitment practices, arrangements to support staff, training arrangements, disciplinary procedures, and ongoing checks? Wording aligned with health All services Substantive change Do staff receive effective training in safety systems, processes and practices? Wording aligned with health All services S4 Substantive change How does the provider ensure the proper and safe use of medicines?

8 Feedback from consultation and wording aligned with health Substantive change Is the service s role in relation to medicines clearly defined and described in relevant policies, procedures and training? Is current and relevant professional guidance about the management of medicines followed? Feedback from consultation and wording aligned with health Services that administer medicines as part of providing regulated activity Key lines of enquiry and prompts : SAFE Key lines of enquiry, prompts and ratings characteristics adult social care services 7 Code Key line of enquiry / prompt Reason for change Applies to Substantive change How does the service make sure that people receive their medicines (both prescribed and non-prescribed) as intended (including controlled drugs and as required medicines), and that this is recorded appropriately? Feedback from consultation and wording aligned with health Substantive change How are medicines ordered, transported, stored, and disposed of safely and securely in ways that meet current and relevant legislation and guidance?

9 Feedback from consultation and wording aligned with health Substantive change Are there clear procedures for giving medicines covertly, in line with the Mental Capacity Act 2005? Feedback from consultation How does the service make sure that people s behaviour is not controlled by excessive or inappropriate use of medicines? Substantive change How do staff assess the level of support a person needs to take their medicines safely, particularly where there are difficulties in communicating, when medicines are being administered covertly, and when undertaking risk enablement assessments designed to promote self-administration? Feedback from consultation and wording aligned with health Key lines of enquiry and prompts : SAFE Key lines of enquiry, prompts and ratings characteristics adult social care services 8 Code Key line of enquiry / prompt Reason for change Applies to New How does the service engage with healthcare professionals in relation to reviews of medicines at appropriate intervals?

10 Feedback from consultation New How do staff make sure that accurate, up-to-date information about people s medicines is available when people move between care settings? How do medicines remain available to people when they do so? Feedback from consultation and wording aligned with health S5 How well are people protected by the prevention and control of infection? All services Substantive change What are the arrangements for making sure that premises are kept clean and hygienic so that people are protected from infections that could affect both staff and people using services? All services responsible for premises, hygiene and cleanliness Do staff understand their roles and responsibilities in relation to infection control and hygiene? All services Substantive change Are policies and procedures maintained and followed in line with current relevant national guidance? All services New Where it is part of the service s role to respond to and help to manage infections, how does the service make sure that it alerts the right external agencies to concerns that affect people s health and wellbeing?